In a concerning development, NHS trusts in England are warning that waiting lists for people with attention deficit hyperactivity disorder (ADHD) are being clogged by patients returning to the NHS after encountering issues with private assessments.
The major NHS trust has revealed that individuals referred by GPs to private clinics using health service funding are increasingly requesting to be transferred back to NHS care, as the private assessments do not always comply with guidelines from the National Institute for Health and Care Excellence (NICE). Furthermore, some private providers lack the appropriate staff qualifications to support continued prescribing.
The consequences for patients can be severe. Some are facing prescription costs of over £200 per month after their GPs could no longer work with the private clinics under shared care agreements. One father whose son’s shared care agreement was withdrawn after three years said the sudden stoppage of medication has had a devastating impact, jeopardising his son’s ability to maintain his job and daily functioning.
The Midlands Partnership NHS Foundation Trust (MPFT) acknowledged in a letter that it is struggling to cope with the growing number of patients being sent back to the trust from private clinics. This is contributing to long waiting lists, reduced capacity for new and complex cases, and increasing risks of delays and gaps in care.
The warning comes after revelations that the NHS in England is overspending by £164 million per year on ADHD services, with a growing proportion of that spending going to poorly regulated private assessments. Demand for assessments has reached record levels as awareness of the condition has increased, leaving NHS services stretched thin, with over 500,000 people now waiting to be assessed.
To address the surge in demand, the NHS is paying private providers to carry out assessments and, in some cases, provide treatment through prescribing. This is often done through the “right to choose” pathway, which allows patients in England to select a private provider for assessment, diagnosis, and initial treatment. Patients can then apply for a shared-care agreement, under which their GP continues prescribing alongside the private provider.
However, the system is often fragmented and lacks clear clinical standards. The MPFT letter highlighted the challenges and limitations associated with the right to choose for ADHD services, noting that private providers can establish services and request to be ADHD diagnosis providers, but their assessments may not always comply with NICE guidelines, and there may be issues ensuring the availability of appropriately skilled staff to support prescribing.
In response to these concerns, the local integrated care board has introduced a right to choose vetting service. The NHS Staffordshire and Stoke-on-Trent ICB has stated that it is committed to ensuring patients receive the care and medication they need and is working with partners to review this case and its wider processes for working with private providers.
